COSGROVE-EDWARDS MITRAL RING DYNAMICS MEASURED WITH TRANSESOPHAGEAL 3-DIMENSIONAL ECHOCARDIOGRAPHY

Background. Flexible rings have been introduced for improved mitral va lve annuloplasty. These rings allow systolic-diastolic variation of bo th the shape and the area of the valve orifice, mimicking the normal d ynamics of the mitral valve ring. In humans, information on the functi onal behavior of the Cosgrove-Edwards ring during the cardiac cycle is limited at present. Methods. We used transesophageal three-dimensiona l echocardiography to analyze mitral valve rings in 19 consecutive pat ients who underwent annuloplasty because of severe (grade III to IV) m itral regurgitation. Fifteen patients received a Cosgrove-Edwards ring and 4 received a Carpentier ring. The acquisition for three-dimension al reconstruction was performed using the transesophageal rotational t echnique, immediately after operation. Horizontal cross-sections throu gh the mitral valve ring were selected from the data sets for measurem ent of the dimensions and surface area of the mitral valve orifice at end-systole and end-diastole. Measurements of the flexible Cosgrove-Ed wards ring and the rigid Carpentier ring were compared. Results. Adequ ate images-for measurements were obtained in 17 of 19 patients. The en d-systolic orifice area of the Cosgrove-Edwards ring was 4.21 +/- 1.50 cm(2) (mean +/- standard deviation) and the end-diastolic area was 4. 81 +/- 1.56 cm(2) (p < 0.0001). No significant change in the orifice a rea of the Carpentier ring was observed. Conclusions. Three-dimensiona l transesophageal echocardiography allows the functional assessment in vivo of mitral valve annuloplasty rings. The Cosgrove-Edwards ring ma intains its flexibility early after implantation and demonstrates sign ificant systolic-diastolic changes in the orifice area during the card iac cycle. (C) 1998 by The Society of Thoracic Surgeons.